Research Reports - Acute alcohol intoxication and long-term outcome in patients with traumatic brain injury

J Neurotrauma. 2015 Jan 15;32(2):95-100

Raj R(1), Skrifvars MB, Kivisaari R, Hernesniemi J, Lappalainen J, Siironen J

The effect of blood alcohol concentration (BAC) on outcome after traumatic brain
injury (TBI) is controversial. We sought to assess the independent effect of
positive BAC on long-term outcome in patients with TBI treated in the intensive
care unit (ICU). We performed a retrospective analysis of 405 patients with TBI,
admitted to the ICU of a large urban Level 1 trauma center between January 2009
and December 2012. Outcome was six-month mortality and unfavorable neurological
outcome (defined as a Glasgow Outcome Scale score of 1 [death], 2, [vegetative
state], or 3 [severe disability]). Patients were categorized by admission BAC
into: no BAC (0.0‰; n=99), low BAC (<2.3‰; n=140) and high BAC (≥2.3‰; n=166).
Logistic regression analysis, adjusting for baseline risk and severity of
illness, was used to assess the independent effect of BAC on outcome (using the
no BAC group as the reference). Overall six-month mortality was 25% and
unfavorable outcome was 46%. Multivariate analysis showed low BAC to
independently reduce risk of six-month mortality compared with no BAC (low BAC
adjusted odds ratio [AOR] 0.41, 95% confidence interval [CI] 0.19-0.88, p=0.021)
and high BAC (AOR 0.58, 95% CI 0.29-1.15, p=0.120). Furthermore, a trend towards
reduced risk of six-month unfavorable neurological outcome for patients with
positive BAC, compared to patients with negative BAC, was noted, although this
did not reach statistical significance (low BAC AOR 0.65, 95% CI 0.34-1.22,
p=0.178, and high BAC AOR 0.59, 95% CI 0.32-1.09, p=0.089). In conclusion, low
admission BAC (<2.3‰) was found to independently reduce risk of six-month
mortality for patients with TBI, and a trend towards improved long-term
neurological outcome was found for BAC-positive patients. The role of alcohol as
a neuroprotective agent warrants further studies.

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